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Impact of Remimazolam on Postoperative Delirium in Elderly Non-Cardiac Surgery Patients Admitted to the ICU: A
Zeifei Zhu1,2, Guanyu Yang3, Qinjun Chu3
1Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
Background:
Postoperative delirium (POD) is a common complication. Remimazolam, a novel ultra-short-acting benzodiazepine, has been introduced in anesthesia practice, but its impact on the incidence of POD remains unclear. This study aims to evaluate the association between intraoperative use of remimazolam and the incidence of POD.
Methods:
In this retrospective cohort study, patients aged 65 years and older who underwent elective non-cardiac surgery and were directly transferred to the ICU postoperatively were included. Based on intraoperative use of remimazolam, patients were categorized into the remimazolam group or the non-remimazolam group. The primary outcome was the incidence of POD within seven days postoperatively or until discharge (whichever occurred first), assessed using the CAM-ICU or the 3D-CAM. Propensity score matching (PSM) and multivariable logistic regression analyses were performed to adjust for potential confounders.
Results:
After PSM, 826 pairs of patients were analyzed. The overall incidence of POD was 10.29%. The incidence of POD was 9.32% in the remimazolam group and 11.26% in the non-remimazolam group (P = 0.225). Multivariable logistic regression showed that remimazolam use was not significantly associated with POD incidence (aOR = 0.810, 95% CI = 0.588-1.113, P = 0.196). Intraoperative use of dexmedetomidine was associated with a reduced incidence of POD (aOR = 0.345, 95% CI = 0.236-0.511, P < 0.001), while postoperative administration of esketamine was an independent risk factor for POD (aOR = 2.644, 95% CI = 1.269-5.156, P = 0.006).
Conclusion:
In elderly patients undergoing non-cardiac surgery, intraoperative use of remimazolam was not significantly associated with the incidence of postoperative delirium.
Insights
Intraoperative remimazolam did not significantly impact postoperative delirium (POD) in elderly surgical patients. Further research should explore other factors influencing POD incidence.
Area of Science:
- Anesthesiology
- Geriatric Medicine
- Critical Care Medicine
Background:
- Postoperative delirium (POD) is a frequent complication in elderly patients following surgery.
- Remimazolam, a modern ultra-short-acting benzodiazepine, is increasingly used in anesthesia, but its effect on POD is not well-established.
Purpose of the Study:
- To investigate the association between intraoperative remimazolam administration and the incidence of POD in older adults undergoing elective non-cardiac surgery.
Main Methods:
- A retrospective cohort study included patients aged 65+ undergoing elective non-cardiac surgery.
- Patients were grouped based on intraoperative remimazolam use.
- Propensity score matching and multivariable logistic regression were employed to analyze POD incidence within seven days post-surgery.
Main Results:
- Analysis of 826 matched pairs revealed no significant difference in POD incidence between remimazolam and non-remimazolam groups (9.32% vs. 11.26%, P=0.225).
- Remimazolam use was not independently associated with POD (aOR=0.810, P=0.196).
- Intraoperative dexmedetomidine use correlated with reduced POD, while postoperative esketamine increased POD risk.
Conclusions:
- Intraoperative remimazolam does not appear to significantly influence the incidence of postoperative delirium in elderly patients undergoing non-cardiac surgery.
- Dexmedetomidine may have a protective effect against POD, whereas esketamine is identified as a risk factor.
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